Pertussis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]; Rim Halaby, M.D. [3]

Pertussis Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Pertussis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Pertussis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Pertussis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Pertussis medical therapy
CDC onPertussis medical therapy
Pertussis medical therapy in the news
Blogs on Pertussis medical therapy
Directions to Hospitals Treating Type page name here
Risk calculators and risk factors for Pertussis medical therapy

Overview

Early management of pertussis is very important. A reasonable guideline is to treat individuals aged >1 year within 3 weeks of cough onset and infants ages <1 year and pregnant women (especially near term) within 6 weeks of cough onset. The preferred antimicrobial agent for treatment of pertussis is either Azithromycin, Clarithromycin or Erythromycin. Trimethoprim-sulfamethoxasole can be used in those patients who are unable to tolerate macrolide antibiotics. An alternative drug to Azithromycin may be administered to those who have known cardiovascular disease.

Medical Therapy

Bordetella pertussis

• 1. Whooping cough

• 1.1. Adults

• Preferred regimen (1): Azithromycin 500 mg PO single dose on day 1 THEN 250 mg PO qd on 2-5 days
• Preferred regimen (2): Erythromycin 2 g/day PO qid for 14 days
• Preferred regimen (3): Clarithromycin 1 g PO bid for 7 days.
• Alternative regimen (intolerant of macrolides): Trimethoprim 320 mg/day AND Sulfamethoxazole 1600 mg/day PO bid for 14 days

• 1.2. Infants <6 months of age

• 1.2.1. Infants <1 month

• Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
• Preferred regimen (2) (if azithromycin unavailable): Erythromycin 40-50 mg/kg/day PO q6h for 14 days
• Note: TMP-SMX contraindicated for infants aged < 2 months

• 1.2.2. Infants of 1-5 months of age

• Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
• Preferred regimen (2): Erythromycin 40-50 mg/kg/day PO qid for 14 days
• Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days
• Alternative regimen: For infants aged ≥ 2 months TMP 8 mg/kg q24h AND SMX 40 mg/kg/day PO bid for 14 days

• 1.3. Infants ≥6 months of age-children

• Preferred regimen (1): Azithromycin 10 mg/kg single dose THEN 5 mg/kg (500 mg Maximum) qd for 2-5 days
• Preferred regimen (2): Erythromycin 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
• Preferred regimen (3): Clarithromycin 15 mg/kg PO (1 g daily Maximum) bid for 7 days
• Preferred regimen (4): TMP 8 mg/kg/day AND SMX 40 mg/kg/day bid for 14 days

• 2. Post exposure prophylaxis

• Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
• Note (1): Post exposure prophylaxis to an asymptomatic contacts within 21 days of onset of cough in the index patient can potentially prevent symptomatic infection
• Note (2): Close contacts include persons who have direct contact with respiratory, oral or nasal secretions from a symptomatic patient (eg: cough, sneeze, sharing food, eating utensils, mouth to mouth resuscitation, or performing a medical examination of the mouth, nose, throat.
• Note (3): Some close contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged < 1 year , persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency and cystic fibrosis.

References

Template:WH Template:WS